The fear that gets you there and the fear that stops you

You might expect that the people who put off tests are the ones who don't worry enough. One careful study suggests something more interesting, and it changes what the task is.

Charlotte Vrinten, Jo Waller, Christian von Wagner and Jane Wardle worked with people who were part of a large British trial of bowel cancer screening. Nearly 8,000 of them filled in a questionnaire that measured three different aspects of cancer fear. One was whether they feared cancer more than other diseases. The second was whether they worried about cancer often. The third was whether they found thoughts about cancer uncomfortable. People were asked whether they'd accept an invitation to be screened. Some were then invited, and the researchers checked from clinic records who turned up.

The first two kinds of fear, fearing cancer more than other diseases and worrying about it a lot, made people more likely to say they intended to be screened. They more than doubled the odds. But neither made any difference to whether people attended. The third kind was different. People who found thoughts about cancer uncomfortable were no less likely to intend to go. But they were less likely to turn up.

So the people who stayed away weren't the unworried ones. They intended to go, and they couldn't bear to think about it. Intending takes a moment and can be done at a distance. Attending requires you to hold the subject in mind for long enough to read the letter, make the arrangements and get yourself there. If the thought is painful enough that you flinch away from it each time, none of those steps gets done, however sincerely you meant to do them.

I think this describes the putting off precisely. You've never decided not to get the mole looked at. You've intended to for six months. What happens is that each time the thought comes, it's uncomfortable, and you move your mind off it within seconds. The respectable reasons from chapter 1 are how the moving gets done. Nothing gets booked, because booking would mean staying with the thought for the four minutes it takes.

If that's right, then the task isn't to become less afraid. I couldn't tell you how to do that, and you may have good reason to be afraid. What you need is to be able to stay with the thought for four minutes. Anyone can manage that, with a bit of preparation.

One piece of research suggests what the preparation might be. Jennifer Howell and James Shepperd ran three studies in which people filled in a risk calculator for a medical condition and were then offered the choice of seeing their result or not. The condition was fictitious, though the participants didn't know that. Some participants first did a short exercise that the researchers call affirmation. They reflected on something they valued about themselves or their lives. Those participants were less likely to avoid their results. The effect held even when the result might oblige them to do something unpleasant, and when the disease was described as untreatable.

The theory behind it is that threatening information is easier to face when your sense of yourself feels secure. If you've just been reminded of what matters to you and what you're good for, a piece of bad news is one fact among many. It doesn't feel like a verdict on your whole existence.

These were laboratory studies with an invented disease, and carrying them over to a real phone call is my step. But it costs nothing to try, and chapter 12 builds it in. Before you make the call, spend two minutes on who and what you're doing it for. Think of the people who'd want you to go, and the things you intend to be around for. Then dial while that's still in your mind.